It was not that long ago that most medical authorities urged that if a woman were over 40 years old, ovaries should be removed at the time of hysterectomy. The reasons were twofold - that ovarian cancer was too difficult to diagnose so removal would prevent a dread disease and also, that the risk of subsequent surgery for benign disease was significant. Moreover, hormone therapy would ameliorate some of the side effects of removal.
Today, the pendulum has shifted. For premenopausal women, the ovaries produce hormones which have incredible benefits - protection against heart disease and bone loss being two. Oophorectomy may also affect mental health and sexuality. Moreover, ovarian removal causes acute onset of menopausal symptoms. While estrogen administration is surely helpful, it turns out that a patient compliance is often an issue with many women simply ceasing to take the medication long term - human nature.
What about cancer? Again, the risk of subsequent ovarian cancer for most women is about 1.4 %. This drops even further with a history of pregnancies and use of oral contraceptives.
The risk of subsequent surgery is also lower, especially with the improved resolution of transvaginal ultrasound, allowing many asymptomatic benign entities to be followed.
What about the older woman? Even here, the evidence for ovarian removal is not clear cut and ovarian conservation should be an option.
There is one asterisk - the woman with a strong family history of breast and/or ovarian cancer. Here, the woman may carry a BRCA mutation and genetic counseling is advised. Those who carry such a mutation are the exceptions for whom risk reductive removal of the tubes and ovaries would be strongly advised.
OBG Management has a useful algorithm:
I'm quite certain that with further advances in diagnosis and therapy, management will be tweaked further. Stay tuned.
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